Provider Demographics
NPI: | 1700228079 |
---|---|
Name: | NORTHAMPTON ENDOSCOPY CENTER LLC |
Entity Type: | Organization |
Organization Name: | NORTHAMPTON ENDOSCOPY CENTER LLC |
Other - Org Name: | TWIN RIVERS ENDOSCOPY CENTER |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | DIRECTOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | SOPHIA |
Authorized Official - Middle Name: | L |
Authorized Official - Last Name: | ARWOOD |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 615-625-6038 |
Mailing Address - Street 1: | 20 COMMUNITY DR |
Mailing Address - Street 2: | |
Mailing Address - City: | EASTON |
Mailing Address - State: | PA |
Mailing Address - Zip Code: | 18045-2658 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 610-258-0982 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 20 COMMUNITY DR |
Practice Address - Street 2: | |
Practice Address - City: | EASTON |
Practice Address - State: | PA |
Practice Address - Zip Code: | 18045-2658 |
Practice Address - Country: | US |
Practice Address - Phone: | 610-258-0982 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2013-07-26 |
Last Update Date: | 2013-07-30 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
PA | 261QE0800X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QE0800X | Ambulatory Health Care Facilities | Clinic/Center | Endoscopy |